Provider Demographics
NPI:1235588724
Name:TERESA LONG PHYSICAL THERAPT INC
Entity Type:Organization
Organization Name:TERESA LONG PHYSICAL THERAPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-552-3530
Mailing Address - Street 1:1119 LAKE BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5239
Mailing Address - Country:US
Mailing Address - Phone:502-552-3530
Mailing Address - Fax:502-244-5844
Practice Address - Street 1:1119 LAKE BLUFF CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5239
Practice Address - Country:US
Practice Address - Phone:502-552-3530
Practice Address - Fax:502-244-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002535252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency